Diabetes patients face serious COVID-19 complications, Keep Sharp: Build a Better Brain at Any Age Book. 1 Too much cholesterol puts you at risk for heart disease and stroke, two leading causes of death in the United States. Thus, these recommendations do not pertain to persons with very high cholesterol levels (ie, LDL-C >190 mg/dL) or familial hypercholesterolemia, as they were excluded from most prevention trials. Among the recommendations was that people 40 to 75 years of age without clinical ASCVD and diabetes should take statins if they have an LDL cholesterol level of 70 to 189 mg/dL and an estimated 10-year ASCVD risk of 7.5% or more. Given the lack of studies on screening for and treatment of dyslipidemia in adults aged 20 to 39 years, more research is needed to examine the efficacy of screening and treatment in this age group. FDA answers six common questions. The ACC and AHA recommend statin use in asymptomatic adults aged 40 to 75 years without a history of CVD who have an LDL-C level of 70 to 189 mg/dL if they also have diabetes (use of moderate- to high-dose statins is recommended, depending on the patient’s 10-year CVD event risk) or an estimated 10-year CVD event risk of 7.5% or greater, as calculated with the Pooled Cohort Equations risk calculator (shared decision making is recommended before initiating use of moderate- to high-dose statins). For the purposes of this recommendation, dyslipidemia is defined as an LDL-C level greater than 130 mg/dL or a high-density lipoprotein cholesterol (HDL-C) level less than 40 mg/dL (to convert HDL-C values to mmol/L, multiply by 0.0259). As such, any decision to initiate use of low- to moderate-dose statins in this population should involve shared decision making that weighs the potential benefits and harms and the uncertainty surrounding individual CVD risk prediction. As such, the likelihood that patients will benefit from statin use is directly associated with their absolute baseline risk of experiencing a CVD event. WW will help you build a customized weight loss plan. No other trials noted this outcome. Statin Regimens Used in Available Trials, https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/conflict-interest-disclosures, http://tools.acc.org/ASCVD-Risk-Estimator/, https://www.choosingwisely.org/societies/amda-the-society-for-post-acute-and-long-term-care-medicine/, USPSTF Program Office - 5600 Fishers Lane, Mail Stop 06E53A, Rockville, MD 20857, Adults aged 40 to 75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater. Please use the link(s) below to see the latest documents available. The USPSTF concludes that adults who smoke or have dyslipidemia, diabetes, or hypertension and a 10% or greater 10-year CVD event risk should be offered a low- to moderate-dose statin. However, evidence concerning the association between statin use and diabetes mellitus is mixed, with 1 prevention trial suggesting that there may be a small increased risk of developing diabetes with use of high-dose statins. Having high levels of LDL cholesterol can lead to plaque buildup in your arteries and result in heart disease or stroke. Use of low- or moderate-dose statins was associated with a reduced risk of all-cause mortality (pooled risk ratio [RR], 0.86 [95% CI, 0.80 to 0.93]), cardiovascular mortality (RR, 0.82 [95% CI, 0.71 to 0.94]), ischemic stroke (RR, 0.71 [95% CI, 0.62 to 0.82]), heart attack (RR, 0.64 [95% CI, 0.57 to 0.71]), and a composite cardiovascular outcome (RR, 0.70 [95% CI, 0.63 to 0.78]).6, Among the study populations, the proportion of CVD events prevented (ie, the relative risk reduction) was similar across age, sex, race/ethnicity, lipid level, and other risk factor categories.6 Among trials that stratified participants according to a baseline global cardiovascular risk score, similar relative risk estimates were observed among those classified at a higher vs lower CVD event risk.10, 23. A few comments requested clarification on the I statement regarding statin use among adults 76 years and older. Furthermore, a possible target LDL of <70 mg/dl is stated in patients with diabetes and cardiovascular disease. "When I see a patient over 75 who I believe has a relatively long life expectancy and who has elevated cholesterol and maybe some other risk factors, like diabetes or hypertension, I discuss with them the pros and cons of statins and suggest we try one,” says Nissen. § 1320b-10. “So everyone over 75 is at high risk.”. Cells use it to generate energy. 50,54 This includes older patients and those with prediabetes or metabolic syndrome. The USPSTF found no studies that evaluated the effects of statin use on health outcomes in disease-free adults younger than 40 years. Although statin use may be beneficial for the primary prevention of CVD events in some adults with a 10-year CVD event risk of less than 10%, the likelihood of benefit is smaller, because of a lower probability of disease and uncertainty in individual risk prediction. Fewer persons in this population will benefit from the intervention, so the decision to initiate use of low- to moderate-dose statins should reflect shared decision making that weighs the potential benefits and harms, the uncertainty about risk prediction, and individual patient preferences, including the acceptability of long-term use of daily medication. In 2017 I wrote a post entitled “Do Statins Cause Memory Loss?The Science, The Media, The Statin-Denialist Cult, and The Nocebo Effect” which concluded that there was no scientific evidence for cognitive side effects of the widely-utilized statin cholesterol lowering drugs.. With an AARP membership, there’s always more to discover. Patient Population Under Consideration Cardiovascular disease is the leading cause of morbidity and mortality in the United States, accounting for 1 of every 3 deaths among adults.5, Statins are a class of lipid-lowering medications that function by inhibiting the enzyme 3-hydroxy-3-methyl-glutaryl coenzyme A reductase, which is involved in the rate-limiting step in the production of cholesterol. Coenzyme Q10, or CoQ10, is a substance that the human body makes naturally. Now 89, Rivers has been on the drug ever since. Well what a shock, those same two statins at those doses are the most potent TG-lowering statins. Evidence on the potential harms of statin use for the primary prevention of CVD events in adults 76 years and older is very limited. Reliance on a risk calculator such as the Pooled Cohort Equations alone as a basis for prevention may be problematic, given its possible overestimation of risk in some populations. The Statins Clinical Topic Collection gathers the latest guidelines, news, JACC articles, education, meetings and clinical images pertaining to its cardiovascular topical area — … You are 40 to 75 years old with a high risk of developing heart disease or stroke and have an LDL cholesterol level of 70 mg/dL or higher. Dr Bibbins-Domingo reported having consulted for the Institute for Clinical and Economic Review on the cost-effectiveness of a new class of lipid-lowering drugs. ", If statin side effects become an issue, the prescription can often be tweaked. Furthermore, no statin clinical trials enrolled patients based on a specific risk threshold calculated using a CVD risk prediction tool; rather, patients had 1 or more CVD risk factors other than age and sex as a requirement for trial enrollment. Recommendations made by the USPSTF are independent of the U.S. government. AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age. Although this estimate was heavily influenced by the JUPITER, HOPE-3, and ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm) trials10,40 because of their large sample sizes, the estimate was robust in multiple sensitivity analyses.6, Ten trials reported on cardiovascular mortality. Muscle aches occur in about 10 percent of people who take statins. The USPSTF found adequate evidence that use of low- to moderate-dose statins reduces the probability of CVD events (MI or ischemic stroke) and mortality by at least a moderate amount in adults aged 40 to 75 years who have 1 or more CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking) and a calculated 10-year CVD event risk of 10% or greater. Suggests Statins… If statins seem wise for you, ask your doctor if you can take a low dose to minimize any side effects. USPSTF Recommendations App - Prevention TaskForce, Nominate a Recommendation Statement Topic, https://www.uspreventiveservicestaskforce.org, Final Evidence Review: Screening for Dyslipidemia in Younger Adults, Final Evidence Review: Statin Use for the Prevention of Cardiovascular Disease, Evidence Summary: Screening for Dyslipidemia in Younger Adults, Evidence Summary: Statins for Prevention of Cardiovascular Disease in Adults, Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: AFP's Putting Prevention Into Practice, JAMA Patient Page: Lipid Disorders, Screening and Treatment, Members of the U.S. Preventive Services Task Force, Table. Statins available in the United States include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor). You are leaving AARP.org and going to the website of our trusted provider. Javascript must be enabled to use this site. A new NIH/Duke University study is expected to resolve the age question. Over a follow-up period of up to four years, 10 percent of those who discontinued their statins were later admitted to the hospital for cardiovascular problems, compared with only 8 percent of those who stayed on the drugs. Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/conflict-interest-disclosures. This work is subject to the restrictions of Section 1140 of the Social Security Act, 42 U.S.C. It's a natural vitamin, vitamin B3. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults aged 40 to 75 years. Statins also increase the number of LDL receptors on liver cells, which enhances Abbreviations: ACC/AHA=American College of Cardiology/American Heart Association; CVD=cardiovascular disease; LDL-C=low-density lipoprotein cholesterol; HDL-C=high-density lipoprotein cholesterol; USPSTF=US Preventive Services Task Force. Unlike statins, fibrates, resins, and ezetimibe, niacin (nicotinic acid) is available without a prescription. See recommendation 1.3.27 for advice on treatment with statins for people with chronic kidney disease (CKD). The USPSTF found adequate evidence that the harms of low- to moderate-dose statin use in adults aged 40 to 75 years are small. The recommendations are stirring debate over how aggressively to use statins as a primary prevention tool. Those state that you should take a statin if: According to the guidelines, after age 75 you should have a workup with your doctor and a discussion of risks and benefits. Low-density lipoprotein (LDL) or “bad” cholesterol. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. But if you have too much in your blood, it can stick to the walls of your arteries and narrow or even block them. Other advantages are that it can generate sex- and race-specific risk predictions and that it includes ischemic stroke as an outcome. This updated guideline focuses on reducing the risk of ASCVD in four statin benefit groups: (1) persons with clinical ASCVD (i.e., acute coronary syndromes, or a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease of atherosclerotic origin); (2) persons with primary elevations of LDL-C levels of 190 mg per dL (4.92 mmol per L) or greater; (3) persons with diabetes mellitus who are 40 to 75 years o… The USPSTF does not consider the costs of providing a service in this assessment. When making a recommendation on a preventive medication, the USPSTF uses the systematic evidence review to determine how to identify persons in the general population for whom the USPSTF can be moderately certain about the balance of benefits and harms of a preventive medication on health outcomes. Before offering statin therapy, clinicians should discuss the benefits of lifestyle modification and optimize the management of all other modifiable CVD risk factors.45. Healthy lifestyle is still key for preventing heart disease. The trials also found no evidence of an increase in cancer or elevated aminotransferase levels with statin use.6, Evidence on the association between statin use and adverse cognitive effects is very limited, but no clear increase in risk was observed.6 A systematic review of RCTs and observational studies on the effects of statin use for any indication on cognition found no statistically significant differences in performance scores on tests of attention, visual perception, motor and processing speed, memory, cognitive performance, or executive function, and no effect on the incidence of Alzheimer disease or dementia.7, Although muscle pain, soreness, or weakness are commonly reported with statin use, there were no statistically significant differences between the intervention and control groups for myalgia (7 trials; pooled RR, 0.96 [95% CI, 0.79 to 1.16]), myopathy (3 trials; pooled RR, 1.09 [95% CI, 0.48 to 2.47]), or rhabdomyolysis (4 trials; pooled RR, 1.57 [95% CI, 0.41 to 5.99]), although the confidence intervals for the latter 2 conditions were very wide because of a low number of reported events.6, Data from 5 RCTs and 2 observational studies provided evidence on the potential association between statin use and diabetes incidence. But that doesn't mean niacin is right for you. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. When patients do have muscle pain: Actual muscle damage occurs in only 1 in 10,000 patients. The cholesterol test, or screening, requires a simple blood draw. You may need to fast (not eat or drink) for 8 to 12 hours before your cholesterol test. by Beth Howard, AARP, October 29, 2020 Myalgia is a commonly reported adverse effect of statins, but placebo-controlled trial data do not support the conclusion that statin use has a major causative role in its occurrence. Your LDL cholesterol level is 190 mg/dL or higher. Most of the trials, including the recently published HOPE-3 trial,8 enrolled participants based on an elevated LDL-C level, a diabetes diagnosis, or at least 1 CVD risk factor. Another study using data from the Medical Expenditure Panel Survey, which did allow for the differentiation of individuals with and without vascular disease (defined as coronary heart disease, stroke, or peripheral vascular disease), found that the rate of statin use among adults 80 years and older for the purposes of primary prevention increased from about 9% in 1999–2000 to 34% in 2011–2012.30, The Society for Post-Acute and Long-Term Care Medicine, as part of the Choosing Wisely campaign, highlighted the use of cholesterol-lowering medications in adults with limited life expectancy (ie, 70 years and, most particularly, 85 years and older) among its "10 Things Physicians and Patients Should Question" because of the increased likelihood of an overall unfavorable risk-to-benefit ratio.31, The USPSTF has made other recommendations relevant to the prevention of CVD in adults, including aspirin use for the prevention of CVD,32 screening for coronary heart disease using electrocardiography,33 use of nontraditional risk factors in CVD risk assessment,12 screening for high blood pressure,17 screening for abnormal blood glucose levels and type 2 diabetes mellitus,34 interventions for tobacco smoking cessation,18 behavioral counseling to promote a healthful diet and physical activity for CVD prevention in adults,36 and screening for and management of obesity in adults.36. In the USPSTF Recommendation Statement published in the November 15, 2016, issue of JAMA, incorrect data were reported in the text. Limited information is available about use of high-dose statins in a primary prevention population. The American Heart Association recommends that all adults have their cholesterol checked every 4 to 6 years, starting at age 20, which is when cholesterol levels can start to … 50,55 One consistent finding has been that, for each new case of incident diabetes caused by statins, several CVEs can be prevented in higher-risk patients. Fifteen trials used fixed-dose statin therapy, of which the majority evaluated moderate doses; there were no clear differences in estimates when trials were stratified according to dose. The calculator derived from these equations takes into account age, sex, race, cholesterol levels, systolic blood pressure level, antihypertension treatment, presence of diabetes, and smoking status as risk factors. This recommendation statement focuses on the assessment of overall CVD risk to identify adults aged 40 to 75 years without a history of CVD who will benefit most from statin use to reduce their risk of experiencing a CVD event. However, clinicians' ability to accurately identify a patient's true risk is imperfect, because the best currently available risk estimation tool, which uses the Pooled Cohort Equations from the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the assessment of cardiovascular risk, has been shown to overestimate actual risk in multiple external validation cohorts. Adults aged 40 to 75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 7.5% to 10%. However, in the available trials of statin use among adults at increased risk of CVD but without a history of CVD events, benefits have been generally consistent across different clinical and demographic subgroups (even among adults without marked dyslipidemia). High cholesterol has no signs or symptoms, so the only way to know if you have it is to get your cholesterol checked. The Pooled Cohort Equations were derived from prospective cohorts of volunteers from studies conducted in the 1990s and may not be generalizable to a more contemporary and diverse patient population seen in current clinical practice. Two trials directly compared different statin doses but were underpowered to draw reliable conclusions about clinical outcomes. With one caveat: It depends on the patient. The decision to initiate therapy in this population should reflect an assessment of patients’ specific circumstances and their preference for a potential small benefit relative to the potential harms and inconvenience of taking a lifelong daily medication. people ages 75 to 79 experienced a health issue, older people who adhered to their statin prescription. Guidelines issued by the American College of Cardiology and American Heart Association indicate that the benefits of a high-intensity statin outweigh the … Instead of treating to a specific LDL-C target, the ACC and AHA recommend fixed-dose statin therapy using either a high-intensity regimen (daily dose reduces LDL-C level by approximately ≥50%) or a moderate-intensity regimen (daily dose reduces LDL-C level by approximately 30% to <50%).24 In response, the Mayo Clinic established a task force, which generally provides consistent recommendations, although it emphasizes lifestyle modifications rather than statin therapy in adults 40 years and older who have an LDL-C level less than 100 mg/dL or are sufficiently motivated to reduce their CVD event risk to less than 7.5%.43, The Canadian Cardiovascular Society recommends statin therapy combined with health behavior modification in men 40 years and older and women 50 years and older without CVD risk factors and in adults of any age with CVD risk factors who also have a 20% or greater 10-year CVD event risk or an LDL-C level of 135 to 190 mg/dL and a 10% to 20% CVD event risk (based on the Framingham risk score). Your LDL cholesterol level is 190 mg/dL or higher. AHRQ and the US Department of Health and Human Services cannot endorse, or appear to endorse, derivative or excerpted materials, and they cannot be held liable for the content or use of adapted products that are incorporated on other Web sites. 1.1.11 Do not use a risk assessment tool to assess CVD risk in people with an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m 2 and/or albuminuria. These findings are consistent with those from a recent systematic review of RCTs and observational studies assessing the effect of statins on cognition that found no effect on incidence of Alzheimer disease or dementia.7 The recently published HOPE-3 (Heart Outcomes Prevention Evaluation 3) trial found that statin use increased risk of cataract surgery, which was unanticipated and not a predetermined outcome of the trial.8 None of the other primary prevention trials reported this outcome.9. No other authors reported disclosures. “But I watch them much more closely, and I worry about them more. The USPSTF found no clear evidence of decreased cognitive function associated with statin use. In general, if you have diabetes, the American Diabetes Association (ADA) recommends a moderate- or high-intensity statin, in addition to changes to nutrition and activity levels. For example, 41% of men and 27% of women aged 60 to 69 years without a history of CVD will be found to have a calculated 10-year CVD event risk of 10% or greater.16 Many older adults, particularly those aged 65 to 75 years, may meet the recommended risk threshold for treatment with statins in spite of the absence of dyslipidemia, diabetes, hypertension, or smoking. Who really needs the hepatitis B vaccine? “About 1 in 3 Americans will ultimately die from cardiovascular disease,” Lewis says. * Dr Gillman was not affiliated with the National Institutes of Health while he was a member of the USPSTF. These persons should be screened and treated in accordance to clinical judgment for the treatment of dyslipidemia. By doing this, they also appear to help prevent heart attacks and strokes by keeping plaques from breaking apart and forming clots that can move to the heart or brain. For the purposes of this recommendation, dyslipidemia is defined as an LDL-C level greater than 130 mg/dL or a high-density lipoprotein cholesterol (HDL-C) level less than 40 mg/dL (to convert HDL-C values to mmol/L, multiply by 0.0259). The provider’s terms, conditions and policies apply. to search for ways to make a difference in your community at García, MD, MPH (Pima County Department of Health, Tucson, Arizona); Matthew W. Gillman, MD, SM (Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts; now with the National Institutes of Health, Bethesda, Maryland*); Alex R. Kemper, MD, MPH, MS (Duke University, Durham, North Carolina); Alex H. Krist, MD, MPH (Fairfax Family Practice Residency, Fairfax, Virginia and Virginia Commonwealth University, Richmond); Ann E. Kurth, PhD, RN, MSN, MPH (Yale University, New Haven, Connecticut); C. Seth Landefeld, MD (University of Alabama at Birmingham); Michael L. LeFevre, MD, MSPH (University of Missouri, Columbia); Carol M. Mangione, MD, MSPH (University of California, Los Angeles); Douglas K. Owens, MD, MS (Stanford University, Stanford, California); William R. Phillips, MD, MPH (University of Washington, Seattle); Maureen G. Phipps, MD, MPH (Brown University, Providence, Rhode Island); and Michael P. Pignone, MD, MPH (University of Texas at Austin). “There was a 25 percent lower risk of dying from any cause among those who were taking a statin, compared to those who never did — and a 20 percent lower risk of dying from a cardiovascular event, such as a heart attack or stroke, among those who started taking a statin after age 75,” says the study's lead author, Ariela Orkaby, M.D., MPH, a physician scientist at the VA Boston Healthcare System and assistant professor of medicine at Brigham and Women's Hospital.
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